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体外心肺复苏患者中行经皮冠状动脉介入治疗和冠状动脉旁路移植术的紧急冠状动脉血运重建。

Emergent coronary revascularization with percutaneous coronary intervention and coronary artery bypass grafting in patients receiving extracorporeal cardiopulmonary resuscitation.

机构信息

Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.

Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

Eur J Cardiothorac Surg. 2024 Aug 2;66(2). doi: 10.1093/ejcts/ezae290.

Abstract

OBJECTIVES

Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue for refractory cardiac arrest, of which acute coronary syndrome is a common cause. Data on the coronary revascularization strategy in patients receiving ECPR remain limited.

METHODS

The ECPR databases from two referral hospitals were screened for patients who underwent emergent revascularization. The baseline characteristics were matched 1:1 using propensity score between patients who underwent coronary artery bypass grafting (CABG) and those who received percutaneous coronary intervention (PCI). Outcomes, including success rate of weaning from extracorporeal membrane oxygenation (ECMO), hospital survival, and midterm survival in hospital survivors, were compared between CABG and PCI.

RESULTS

After matching, most of the patients (95%) had triple vessel disease. Compared with PCI (n = 40), emergent CABG (n = 40) had better early outcomes, in terms of the rates of successful ECMO weaning (71.1% vs 48.7%, P = 0.05) and hospital survival (56.4% versus 32.4%, P = 0.04). After a mean follow-up of 2 years, both revascularization strategies were associated with favourable midterm survival among hospital survivors (75.3% after CABG vs 88.9% after PCI, P = 0.49), with a trend towards fewer reinterventions in patients who underwent CABG (P = 0.07).

CONCLUSIONS

In patients who received ECPR because of triple vessel disease, the hospital outcomes were better after emergent CABG than after PCI. More evidence is required to determine the optimal revascularization strategy for patients who receive ECPR.

摘要

目的

体外心肺复苏(ECPR)已成为难治性心脏骤停的一种抢救手段,其中急性冠状动脉综合征是常见病因。接受 ECPR 的患者的冠状动脉血运重建策略数据仍然有限。

方法

从两家转诊医院的 ECPR 数据库中筛选出接受紧急血运重建的患者。使用倾向评分对接受冠状动脉旁路移植术(CABG)和经皮冠状动脉介入治疗(PCI)的患者进行 1:1 匹配,比较两组患者的基线特征。比较 CABG 和 PCI 两组患者的脱机成功率、住院生存率和住院幸存者的中期生存率。

结果

匹配后,大多数患者(95%)有三支血管病变。与 PCI(n=40)相比,紧急 CABG(n=40)有更好的早期结果,ECMO 成功脱机率(71.1% vs. 48.7%,P=0.05)和住院生存率(56.4% vs. 32.4%,P=0.04)更高。平均随访 2 年后,两种血运重建策略均与住院幸存者的中期生存率相关(CABG 后 75.3%,PCI 后 88.9%,P=0.49),CABG 组患者的再介入率较低(P=0.07)。

结论

对于因三支血管病变而接受 ECPR 的患者,紧急 CABG 后的住院结局优于 PCI。需要更多的证据来确定接受 ECPR 的患者的最佳血运重建策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9404/11315652/d913ba7e66cf/ezae290f5.jpg

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